June 19, 2000 (San Antonio) -- For babies whose mothers were diabetic during pregnancy, the health problems can be lifelong. These children are at serious risk of obesity, glucose-tolerance problems, and, eventually, type 2 diabetes, say experts who spoke here at the annual meeting of the American Diabetes Association. But this risk can be substantially reduced by screening all pregnant women, they say.
Women who already know they are diabetic should plan their pregnancies very carefully, under a doctor's care, say the experts. But even nondiabetic women should be screened in case they develop a fairly common problem known as "gestational diabetes" -- elevated blood sugar brought about by the pregnancy itself.
The mother often recovers from this condition after she gives birth, but her baby will already have been affected. Further, when a woman has pregnancy-related diabetes, it is a strong clue that she might one day develop type 2 diabetes herself.
Type 2 diabetes -- once called "adult-onset" or "non-insulin dependent" diabetes -- is the most common type of diabetes and is strongly linked to obesity. Today, most health care professionals use the term "type 2" because some of these patients are dependent on insulin and because the disease is not just for adults anymore. With ever-increasing rates of obesity and couch-potato behavior among children, more kids are developing type 2.
In any case, whether a mother has gestational diabetes or whether she had diabetes before becoming pregnant, the child's risk is the same, says Bernard L. Silverman, MD, who spoke at the meeting. Silverman is associate professor of pediatrics at Northwestern University in Chicago, where he is the head of endocrinology at Children's Memorial Hospital.
Silverman and colleagues have been following 600 children of diabetic mothers, all of whom were born between 1978 and 1983. The researchers found that these children have a body-mass index (BMI) range consistently higher than that of children born to nondiabetic mothers. (BMI is a score often used to determine obesity.) Plus, they are four times as likely to have glucose-tolerance problems.
Because of the high levels of blood sugar to which the children were exposed before birth, their bodies produce more insulin to compensate. All this excess insulin may permanently impair the child's beta cells, the cells in the pancreas that secrete insulin, says Rebecca Simmons, MD, who spoke at the meeting. She is a neonatologist at Children's Hospital of Philadelphia.
"The effects of this intrauterine exposure are permanent and difficult to intervene on," Simmons tells WebMD. "We need to be aware of ongoing effects" of exposure to diabetes before birth.
Awareness of the problem may promote some preventive behaviors. For example, if diabetic mothers breast-feed, their children may be less likely to later develop type 2 diabetes. In one study, Simmons and her colleagues found that, among mothers who did not have gestational diabetes, the children who were exclusively breast-fed as infants were less than half as likely to become obese as those who were exclusively bottle-fed.
In addition to glucose, the level of fats, or lipids, and proteins in the mother's blood may play a role in these children's ongoing health risks, says Richard M. Cowett, MD, who also spoke at the meeting.
"Despite the best glucose control, the prospects for infants born to diabetic mothers are compromised," he tells WebMD. "Proteins and lipids are important to monitor," says Cowett, the chair of neonatology at Children's Hospital in Cleveland, Ohio.